Teens enter my office for many different reasons. Most times, parents initiate the contact. Other times, it’s schools. Adults’ concerns are usually—and correctly—about the teen’s safety. So, teens who have problems with self-injury, suicidal thoughts, and aggression are often identified and sent to someone like me. Other behaviors that prompt such action include defiance, oppositional behavior, school refusal, argumentative behavior, and social isolation.

And so treatment begins. And sometimes it’s brief. And more often it’s longer. And when their behavior is regulated, when teens are no longer self-injurying or suicidal, aggressive or using substances…we find the underlying problems. What’s underneath all this unsafe behavior? Would you guess…social anxiety? In my office, I’ve seen a higher-than-expected number of self-injurying teens who actually—before all the unsafe behaviors—had developed Social Anxiety Disorder. And they still have it. Because these kids can be outrageous in appearance and behavior, people often suppose they have similarly bold personalities. Not true.

These teens scowl because they feel as if they are in the glare of the public eye, and that the public is waiting to criticize them. They don’t scowl because they hate the system.

These teens break eye contact not because they don’t like you, but because looking you in the eye paralyzes them with a flood of adrenaline.

These teens end conversations quickly because they are over-analyzing the situation and struggle to think of what to say next. They don’t stop talking because they think you’re boring or stupid.

These teens prefer the company of one close friend—or of no one at all—not because they can’t stand people, but because they can’t stand how they feel around people. It’s miserable.

When I ask these teens how others describe them, one word keeps coming up: “Intimidating.” Their peers tell them that they are intimidating, that they don’t seem to like anyone, and that they are kind of scary. People assume these teens are irritable and that they are verbally or physically dangerous.

But they are none of these, really. They are consumed by a sometimes-panic level of anxiety when they are in social situations. So they’ve found ways to hide anxiety. Some dress in crazy fashions. Others isolate. Some use drugs to feel comfortable around others (this only makes anxiety worse down the road; it’s not a solution). Some teens act obnoxious and outrageous.

Of course, not all self-injurying teens have Social Anxiety Disorder. Many teens dress in crazy clothes because they just like them; they’re not hiding anything. And of course, teens can be obnoxious without any diagnostic label.

But take a look at yourself and your friends…could there be anxiety under all that behavior? If you fix the anxiety, you’ll be more effective. You won’t have to do those things that get you in trouble or draw negative attention. You’ll feel well, again. Like you did when you were a little kid.

Our bodies are made up of traits that are good for our survival and the survival of our species. Every part of us has a function, a purpose. For example, the function of eyes is to see. The function of taste buds is to determine the nutritional value of food and avoid eating poisons.

Our emotions evolved right alongside our bodies. What is the function of emotions? To answer this, think about good ol’ Uncle Caveman. How did fear keep him alive? That’s easy, when he saw a Sabertooth tiger, Uncle Caveman got scared and ran away! Fear gave him the adrenaline, energy, and focus he needed to stay alive.

How did anger keep Uncle Caveman alive? It helped him bargain for his interests better. When another tribe tried to move into his cave, anger created the right motivation for Uncle Caveman to keep his cave (good thing too, what with all those Sabertooth tigers running around). Anger helped Uncle Caveman protect his interests.

What about shame? Shame is a very social emotion, more so than other feelings. When Uncle Caveman did something that disgusted, disappointed, or angered his tribe, he felt shame. Being part of a tribe was critical to Uncle Caveman’s staying alive. The formula is: Alone = Death, Part of Tribe = Survival. Shame helped Uncle Caveman act in pro-social ways so his tribe would not kick him out. (So he had to stop tagging the wooly mammoths).

Sadness for Uncle Caveman was caused by a loss of some sort. I hope one of his children wasn’t eaten by a Sabretooth tiger, but I can’t promise that. Say it happened. Well, sadness did two important things for Uncle Caveman’s survival, and the survival of his tribe. 1) He never forgot that Sabertooth tigers can kill. He told everyone he knew. And he never again asked a Sabertooth tiger to babysit his kids. 2) It made him yearn for his child, and for connection to others. Guess what, this story ends well. Uncle Caveman’s baby actually was hiding that whole time, and since sadness had motivated Uncle Caveman to search for his kid…they lived happily ever after.

Emotions helped Uncle Caveman make decisions that helped him stay alive. The function of emotions is to help us make good decisions, so we don’t get hurt, used, ignored, or run down.

Evolution is a SLOW process. In fact, our bodies are very alike to our cavemen ancestors. Sure, we know a lot more. And we use Facebook and soap. But our bodies—and our brains—are not so different from good old Uncle Caveman!

Emotions evolved in humans like everything else; what was adaptive to the species remained. Emotions are critical to our decision making! That’s why therapists tell people to “understand your emotions.” If you did that better, you’d made better decisions. I promise.

If we all had perfectly tuned emotions, life would be good. But, we are individuals within a species, and we each have different characteristics. That applies to our eye color, height, IQ, athletic ability, and—of course—emotional experiences.

Many mental disorders are characterized by too much—or not enough—of certain emotions. Depression is too much sadness. Anxiety Disorders are too much fear. Personality Disorders may be too much shame and anger. When you notice your feelings remain far beyond their function (remember, they help you make good decisions), they can seriously interfere with your life. If your emotions have outlived their usefulness, talk to a trusted adult (p.s., Sabertooth tigers are not good confidantes). It’s time you had some help.

First Law of (e)Motion: Every emotion tends to remain in that state of emotion, unless an external force is applied to it. If you want your emotion to change, you have to do something to change it. Or else, it stays the same.

A lot of teens tell me that when such-and-such happens, they’ll be happy. When they graduate. When the semester is over. When parents stop worrying about them. When they lose 10 pounds. And, actually, the teens are sort of right. These events act on emotions in a postive way. The problem is, the events don’t sustain happiness. What’s worse, they are often not within a teen’s control (how do you “make” parents stop worrying about you?).

You can apply external force to your emotions, all by yourself. You don’t have to wait for life to affect you. Just understand and follow the next couple laws of (e)Motion.

Second Law of (e)Motion: The relationship between feelings, ideas, and behaviors is (Feelings = Ideas x Behaviors). Your thoughts and behaviors create how you feel, even if you’re not trying to create any feelings.

Your ideas are in fact powerful messages to your physiology. They create neurochemical events that generate feelings. When you sit in class thinking, over and over: “This is so boring,” you are refiring the emotion of irritability. If you tell yourself how awkward you are at a party, you create anxiety. If you focus on all the things you “need” but don’t have (e.g., better clothes, better body, higher grades, cooler friends, nicer parents), you sustain sadness.

Behavior also plays a role in creating emotions.

For example, there is such a thing as “acting depressed.” This doesn’t mean faking depression. It means behaving in ways that are consistent with depression. Sleeping a lot. Over-eating. Not exercising. Seeking out sad movies/songs. Isolating yourself. Not showering. You’re depressed, so why bother, right?

There is such a thing as “acting anxious,” which is basically avoiding things that make you uncomfortable or nervous. So you don’t try out for the team. And you don’t tell your classmate to stop putting you down. You don’t go on the rollercoaster with your friends. And you don’t tell the Starbucks barista she messed up your $7 drink. You’re anxious, after all, and those things are pretty uncomfortable, right?

Irritability can be created by not getting enough sleep and by skipping meals. It can be sustained by stomping around the house complaining, giving mean looks to people around you, and trying to get through the day as quickly as possible. Irritability can be strengthened by procrastinating on homework you know you have to do, and by bickering with siblings. You’re grumpy, and it’s the world’s fault, right?

You don’t even have to try to create emotions. You’re already doing it. You probably do it most of the time. Like now, how are you feeling and what are you thinking/doing to sustain that feeling? If you want to create happiness, follow the Third Law of (e)Motion…

Third Law of (e)Motion: For every idea and behavior, there is an opposite and equal idea and behavior. When you act and think opposite to how you feel, you will change your feeling.

Emotions won’t hurt you. They can be unpleasant. So what: they don’t last forever! If you can successfully tolerate and manage your feelings in the moment, you’ve mastered the Laws of (e)Motions!

When we’re upset, we often think and act in ways that make things worse. The master of (e)Motion does this: act and think contrary to how you feel. Do the opposite thing. If you don’t feel like going to the gym…go to the gym! If you are afraid to ask for help…ask for help! If you are thinking about all your flaws…think about all the great things about you!

When you think and behave opposite to how you feel, you change your emotion. It really can be that simple. You are not at the mercy of your feelings. Apply force with your thoughts and behaviors, and start to feel better.

Stress is how you respond to “stressors.” And stressors are most of the things in your life: parents, grades, personal appearance, falling in love, friends, prom, teachers, jobs, clubs, college applications, break-ups, mid-terms. It can seem like stress is just a natural part of teen life.

People have different thresholds for stress. You probably know people who are quite happily busy for 18 hours a day. You also know folks who seem overwhelmed with just the idea of a to-do list. If you’re like most teens, you’re somewhere in the middle: working to balance the parts of your life, effectively. You are probably doing the best you can. And, still, you’re feeling stressed out.

Stress is a mean relative of anxiety. Anxiety has lots of relatives, and not all of them are bad. Many people who achieve at high levels have a drive to do well that can cause anxiety. So, goal-achievement is a nicer relative of anxiety. Conscientiousness—how aware we are of ourselves and others—is also related to normal anxiety: another nice relative. But, stress…he’s a mean one.

Stress is the unwanted, vague, suffocating, terrorizing relative that tends to overstay his welcome. When stress stays too long, it is bad for you. You’ve probably heard: chronic stress is associated with poor sleep, lowered immune deficiency, inflammation that damages your body’s cells, acne, high blood pressure, aches, weight gain, and gastrointestinal problems. Stress makes you feel inept. In a world of problems, it blocks every potential solution from your view. Like I said: mean.

So how do you manage stress effectively? Dialectal Behavior Therapy (DBT) would tell us to try reducing our emotional vulnerability. Use the P.L.E.A.S.E. skill. Stress really is in your body, not just in your mind. So, the first step in countering stress is to take care of your body. The P.L.E.A.S.E. skill is a guide for this. When your body is healthy, it’s better prepared to manage the daily stressors that are part of life. And, should a big stressor present itself (finals!), you’ll be ready to take them on, too.

P: Physical and L: HeaLth. (L fits, see?)Take care of your body. If you’re sick, treat the illness, first and foremost. Your body is telling you something: “take care of me.” So, rest. Take medications as prescribed by your doctor. These may be your vitamins, antibiotics, psychotropics, blood thinners, inhalers…whatever your doctor and parents both agree is right for you, take those medications as prescribed.

E: Eating. Balance your eating. Don’t eat too much. Don’t eat too little. Both can make you feel ridiculously tired. Over-and under-eating can cause clinically significant levels of inattention. They lead to moodiness, including especially irritability. Both over-eating and under-eating can become all-consuming, where the thing you think about most is food. That makes it hard to be effective in life.

Eat good foods. They really make a difference. Whole grains. Fruit and vegetables. Lots of water. If you love carbohydrates, try to move those into the evening hours. Your best concentration/energy foods are the proteins, and it’s a worthwhile goal to include a protein at every meal. Good protein sources are almonds, soybeans, cheese, milk, chicken, and energy bars. Sugars and fats aren’t just hanging out at the top of the food pyramid, they are wreaking havoc on your concentration and mood. So, avoid those. They taste good, but the cost on your effectiveness is just too high.

A: Altering. Avoid non-prescribed mood altering substances and behaviors. You got it—that means drugs. People who habitually and regularly use illegal substances have higher rates of depression, lower academic performance, lower relationship satisfaction, lower self-esteem, and fewer reasonable future goals. Mood-altering behaviors are usually dangerous, and unnecessarily so. Cutting yourself or otherwise harming yourself can be mood-altering. It can be mood-altering to drive 100mph down a country road. Such unsafe and impulsive behaviors do not reduce stress in the long-term. In fact, 9 times out of 10, they just end up making things worse for you.

S: Sleep. Sleep is like food for your brain. It is the time when today’s learning experiences consolidate and go into long-term storage (you may experience this as dreaming). That’s why people advise you to get a good night’s sleep before a test. Sleep is also when important neurochemicals and hormones are released to support your growth and brain functioning. Poor sleep leads to impaired concentration, zits, impulsivity, irritability, weight gain, and vulnerability to illness.

If you’re like many teens, sleep is the first thing you de-prioritize in your schedule. You may cut into sleep hours without a second thought. Like, staying up late to study, work, or (electronically) socialize. Some set early alarms to finish up a paper or get in a workout. If you take nothing else away from this article, take this: PROTECT YOUR SLEEP. Defend it. Honor it. You need it.

Teens need between 8-11 hours of sleep a night. If you can’t fit your obligations comfortably into the other 13-16 hours a day, then you’re doing too much. Barriers to sleep are more prevalent than you may know. Barrier #1 and #2: your cell phone and IPAD. Scientists have found that the LED screens in hand-held devices interfere with your brain functioning in ways that delay sleep onset. Barriers #2, #3, and #4: your TV, video games, and personal computer. While TV and video games do not have the LED component, they can be pretty tough to turn off when you’re tired at night. Take-home message is this: put your electronics to bed at least one hour before you’d like to be asleep.

E: Exercise. Just do it. Aim for a minimum of 3 workouts a week. Workouts should last at least 30 minutes, and they should get your heart really pumping. Working out with a friend is a fun way to stick to a regimen. With exercise, remember: the cart usually comes before the horse. Not many people “feel like” working out until they are well into their workout. If you wait around until you feel like exercising, it may never happen. But you’ll notice that, once you get started, the motivation to workout follows. If you’re having a lot of trouble with exercise, research shows that just taking a few minutes to visualize your workout can increase your motivation and readiness.

Stress is a normal part of life. But it can be really difficult to manage. If your struggles with stress are more intense, these are your warning signs:

• feeling sad/irritable more days than not, and for most of each day
• worrying about almost everything, like your mind can’t stop going
• needing more than one hour to fall asleep, or waking up a lot at night
• gaining/losing 10+ pounds in one month
• thoughts of death, suicide, or self-harm
• thoughts or plans to hurt others
• feeling hopeless, or like nothing matters
• changing your life goals drastically within the past month (e.g., “I don’t care if I graduate.”)
• headaches, stomachaches, or indigestion
• isolating yourself from friends
• feeling ineffective (pushed over) in relationships
• wondering, “what’s the point?” of taking care of yourself
If you have any of these signs, then the P.L.E.A.S.E . skill alone may not help much. You should talk to a mental health professional. Seek out your school support staff to see if therapy may be helpful for you.

It’s not that your opinion doesn’t matter (although, to your teen, it probably doesn’t). It’s that your child does not believe you. And, your nice words don’t help. They may even hurt.

Most teens I’ve worked with seriously doubt the motives behind their parents’ compliments. Some explain: “My mom says I’m pretty because she feels sorry for me,” “My dad says I’m smart because he has to. He’s my dad,” “My parents say I’m good just to make me feel better.” These teens can twist warm parental encouragement into a shaming experience.

Think of it this way. Imagine (or remember when) your son fell off his bike at age 5, and you announced cheerfully: “You’re fine! Just keep going!” But he actually didn’t feel fine. He was really hurt. Your encouragement may have invalidated his experience. He did not feel understood or supported.

The child who puts herself down does not accept herself. When you insist that she is thin, etc., it invalidates her. She wasn’t understood or supported.

You’ve heard of “vicious cycles…” When you respond with emotional warmth and encouragement to your child’s self-criticisms…you may actually be rewarding her non-acceptance of herself. He learns that he gets flattery and reassurance (even if it’s not totally believable and certainly not enduring) for putting himself down. In a low mood, in a time of self-doubt, she may increasingly berate herself, unconsciously expecting warmth and encouragement. As she negatively judges herself, you amp up compliments, she judges more negatively, and so on.

Self-Criticism through the Ages: How to Respond

Ages 3-4: Surprise: even youngsters this age can come down pretty hard on themselves. Many times, it takes the form of self-harm, such as banging their head on a wall or smacking their face when upset or frustrated.

Ages 5-6: Fit and active children as young as this (boys and girls) have told me they’re “fat.” Body image is no longer just a teen thing. However, self-criticism at this age is more often related to (1) negative mood, (2) frustration, and (3) fears that he/she has disappointed others. Some children may hurt themselves physically. Others use words: “I can’t do this,” “I’m stupid.”

TRY THIS:

Be aware of modeling. Assuming you do not hurt yourself (please don’t do that), your child may be picking up on your self-criticism or overly rigid self-expectations.

Respond to your child as follows. Imagine he has hit another kid, to get you into this mindset.

Adopt a “stop-the-press!” attitude. Stop what you are doing. Look squarely at your child. Without being harsh, be firm. Wear a stern face. Matter-of-factly say, “You are being a bully to yourself. That is not ok. If you do it again, you will get a time out.” If your child repeats it, follow through on time out. If your child stops, wait 1 minute. WAIT. (You do not want to accidentally reinforce self-bullying).

After 1 minute (or after time out): Warmly approach your child and explain what happened: “You spilled the juice on the carpet. That was a mistake. You feel bad about it. I’m pretty irritated, too. But mistakes happen. I really like that you care so much to do the right thing. That’s a nice thing about you. You may not bully yourself. Nobody bullies my kid! Help me clean up this mess now.”

Ages 7-9: The developmental task for these kiddos is to develop industry, to decide if they are skillful, motivated, driven, and productive individuals. This is often decided as they compare themselves to others. This age is where self-esteem starts to solidify. Your opinion as a parent is still very important to your child. Self-criticism at this age may stem from viewing peers are more successful/able/capable/attractive/popular, etc. You may expect unflattering comments related to these.

Ages 10-14: The focus turns more and more toward friends and peers. Your opinion matters less and less. Self-criticism that starts at this age can be a sign of depression and low self-esteem. Ongoing self-loathing has dire social consequences; it is hard to make friends if you don’t like yourself. Occasional self-doubt may be common. It will most often relate to how she sees herself compared to others of her age and gender. A likely source may be peer comments and bullying. Particularly girls who enter puberty early are at risk of negative attention.

Do not let comments go unacknowledged. Giving full attention to your child, say matter-of-factly: “That was a mean thing to say to yourself. Wow.” Your child will probably reassert her self-criticism. Avoid the impulse to correct her or praise her.

Say, “Help me understand that. How are you fat?” Walk your child through a step by step evaluation of his thought process. Continually ask, “What is the evidence?”

What if there is evidence? What if your child is fat? Then, you problem-solve with her. Make an appointment with her pediatrician. Discuss diet and exercise, revising grocery lists, family walks, etc. Make a plan and follow through. All the while, support your child’s self-esteem. Tell her not to bully herself.

Be aware of the validity in your child’s statements. He is probably not the best player on the team. So, what can he do about that? If he wants to improve, help him develop a self-guided practice routine. All the while, support his self-esteem.

You will probably find what’s called a “cognitive error.” It may sound like this: Because I don’t understand algebra, I’m stupid. Explain that error to your child.

Change your tactic. Say, “You are good friend. I notice that you encourage, support, and are gentle with your friends. If your friend did not understand algebra, would you tell him he’s stupid?” You will likely discover that his self-rules do not apply to others. Follow this line of reasoning, with the goal of helping your child develop insight into his overly-high self-standards. “Why are the rules different for you?” Explain that he is bullying himself, and that it won’t be tolerated. Offer to assist him with homework or to find academic supports for him.

Ages 15-19: Self-criticism at this age probably stems from a history of failed attempts at relationships, tasks, or improvements. With teens, there can be a range of triggers for self-criticism. Even if your child only occasionally states self-loathing, it’s probably true that she has chronic negative self-statements in her psyche. Depression may be very likely. Children this age are capable of deeper reasoning, understanding, and dialogue. The self-bullying speech will probably interest him, but not have much effect on curbing self-criticism.

Do not let comments go unacknowledged. Giving full attention to your child, say matter-of-factly, “Whoa. That was a tough thing to say about yourself! Are you okay?” Avoid the impulse to correct her or praise him.

Initiate a dialogue, the goal of which is to show how the self-criticism is mood-dependent—it comes from your child feeling sad, anxious or irritable.

If the comments are not mood-dependent, and made in a cavalier, joking way, say, “That is not acceptable or funny. And it’s not a good habit. Please stop that.”

More likely, the comments are mood-dependent. Help your child identify what triggered the statement, what the mood is, and what she can do to improve her mood. Help her generate coping skills to feel better: listen to music, watch TV, go for a walk, call a friend, read a book, play with the dog, take a shower…

Your child may admit, “Even if I were popular / thin / smart/ athletic, I still would not like myself.” If so, make an appointment with a mental health professional.

Parents want their child’s IQ tested for a variety of reasons. Some are seeking admission to elite schools, where a score in the gifted range is a prerequisite. Others want to know if their child has a learning disability (fact: most people with learning disabilities have average or higher IQ). Still other parents are curious about their child’s intellectual strengths and weaknesses. Lastly, many parents understand the value of incorporating an IQ test into a battery of psychological tests for diagnostic purposes.

Widely-used IQ tests in Illinois include the Wechsler series. David Wechsler was an American psychologist who created IQ tests for adults, children, and very young children. Although he designed the tests several decades ago, they’ve gone through revisions and updates.

Children as young as 2.5 through 6 years old are eligible to take the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Children ages 6 through 16 years old are eligible to take the Wechsler Intelligence Scale for Children (WISC). When a high IQ is suspected in a 6 year old, the WISC is usually administered.

To optimize performance, most kids should take the IQ test in morning hours. (The exception is the rare “night owl” whose thinking is sharpest in afternoon or evening hours). Avoid scheduling an IQ test to occur after school; mental fatigue is likely to detract from your child’s performance.

Depending on your child’s age and test-taking style, IQ tests usually last between 1.5 to 3 hours. Typically, younger children require less time to test. Many children (especially younger ones) need to take breaks between subtests. Snacks, games, a walk outside, or other non-thinking activities are part of testing youngsters. Breaks help them test better.

The IQ test is actually a set of subtests. Children have described the subtests to me as, “kind of like school but funner,” and “like a game sometimes,” “tricky a little,” and “OK.” Your child’s subtest scores are compared to the scores of others within 3 months of his/her age.

IQ is not just one number. IQ tests yeild as many as 15 subtest scores, 4 index scores, and a Full Scale score. Each of these scores is associated with raw scores, percentile ranks, and more. The most meaningful IQ report will include a sea of scores…in a very understandable way.

In order to do well on the IQ test, a child must be: (1) motivated to do his/her best, (2) engaged, (3) focused, and (4) emotionally regulated. A child can do poorly on an IQ test for a variety of reasons, but can do well only if truly able. So, IQ scores can underestimate but not overestimate your child’s intellectual functioning.

Preparing your child for the IQ test should include: ensuring a good night’s sleep, a healthy breakfast (whole grains, fruit, and/or proteins), and the selection of comfortable clothing.

If your child is sick the morning of the test, cancel the test. Even over-the-counter medicated children should be called in sick. Be aware that many medications for colds and allergies can decrease mental processing speed…a highly used skill in IQ tests.

You should also talk to your child about the IQ test. But, avoid using the word “test.” It can create unnecessary anxiety. Instead, say something such as: “You’ll be working for a couple hours with Dr. Ann. She has activities planned for you. Some are like what you do in school. Some are more fun, like word games, blocks, and puzzles. You should ask for breaks when you need them. Ask questions if you’re not sure what you’re supposed to do. The work you’ll do is very important because it helps us know how you think and learn best. Please be on your best behavior and try your hardest. There’s no way to fail in your work. Almost every kid sometimes makes mistakes. Just keep trying and do your best.”

The psychologist should help your child feel comfortable upon introductions. Since anxiety can seriously interfere with test performance, the effective psychologist will be sure to use a variety of strategies to make your child feel mentally prepared and engaged.

Several bright and insightful St. Charles High School students recently visited Plum Tree. They’re finishing Psychology courses and had great questions for a clinical psychologist. Here’s what they wanted to know:

No, but society isn’t clear about how to achieve happiness. Particularly teens are bombarded by social media emphasizing fame, fortune, and beauty. In fact, none of these are linked directly to happiness.

I enjoy a challenge. No science seems as complicated and nuanced as that of human thoughts, feelings, and behaviors.

7. Why did you pick to work with children and adolescents?

I’ve always “spoke their language.” This population of people is easily misunderstood. There’s nothing so fulfilling as being the interpreter between a child and his/her caregivers, teachers, and other important adults.

7. What are the measurable criteria you use to assess how well treatment is working?

It varies per person. Every patient has a treatment plan with measurable goals and timelines. I also conduct intermittent screenings with psychological tests to monitor progress. Of course, patient (and parent) feedback is an important part of assessing the effects of treatment.

8. Do you believe the effects of labeling are true? In the way that when a patient is diagnosed with a certain disorder they act in that labeled way and also the people around them treat them differently according to their diagnosis?

A diagnosis is not a judgment; it’s a fact. Just as there are criteria and scientific evidence to medical diagnoses (e.g., diabetes, colds, cancer) mental illnesses have criteria and scientific evidence. So, just as it’s appropriate and effective to label someone with flu symptoms as having the flu, it’s appropriate and effective to label someone with anxiety symptoms as having anxiety.

Diagnoses (or, labels) are tied to evidence-based treatments, scientific literature, and clinical outcomes. So, when a patient is accurately diagnosed, then treatment pathways become clear. It also allows for different treatment providers to speak the same language about what issues/treatment goals are.

Overwhelmingly, patients can be relieved by learning about their diagnoses. They may have felt “different” all along. The knowledge that there is a name, a treatment, and a community of people with similar issues can be—in itself—an effective therapeutic experience.

Of course, there’s still a lot of public stigma around mental illness. People who have it can be embarrassed or feel inept. Since the idea of mental illness can make others uneasy, patients may experience some ostracizing. Public education is needed.

9. In your opinion, what is the most common diagnosis? Has that changed in the last several years, if so, how?

Trending shows that—for pediatric populations—Bipolar Disorder and Autism Spectrum Disorders, are on the rise. ADHD has been on the rise for at least a decade now, too.

10. Do you think that therapy is the best choice for all who may need it?

Many parents ask me if perfectionism is problematic in kids. It can be. It’s all a matter of adaptiveness. Does perfectionism help or hinder your child? In our fast-paced, information-saturated environments, our children need to continually adapt. But, perfectionism can be the opposite–perfectionism can be rigid and unmoving.

Psychologists typically distinguish between two types of perfectionists: the maladaptive one, and the adaptive one. On paper, these two look alike. They often achieve at the same high level. They have similar high standards. But, one of them is miserable: the maladaptive perfectionist.

The maladaptive perfectionist believes that any less-than-perfect work is unacceptable. They can become preoccupied with details so much that the point of the activity is lost. In fact, perfectionism in this form often interferes with task completion. Maladaptive perfectionists can be excessively devoted to work at the expense of leisure and play. They tend to be inflexible about rules, and come across as rigid and stubborn. Transitions or changes in plans can upset them. Maladaptive perfectionists tend to avoid group work, being unwilling to accept or approve of others’ contributions. Maladaptive perfectionists tend do fine in low-stress situations, but when asked to perform or produce they can become ineffective. Even when achieving at high levels, they tend to be less satisfied with their performance. For example, your child may reason, “I shouldn’t have to work so hard for an A+.” Maladaptive perfectionists have high levels of self-criticism. They are more vulnerable to depression, anxiety, eating disorders, and suicide. But, if asked, these kinds of perfectionists often say that perfectionism is their secret to success.

Adaptive perfectionists also have very high self-standards. But their innate desire to excel does not hinge on a flawless performance. These kids recognize that, sometimes, “perfect” can interfere with success. They are able to sacrifice perfectionism when short on resources (i.e., time, money, parent’s help, etc). These children feel good about a job well done.

There is an overlap between perfectionism and giftedness (children with Superior or higher IQ). Perfectionists and gifted children both have: self-discipline, perserverance, and motivation. These “non-intellectual” factors play a signifcant role in IQ; in fact, they’re requisites. To do well on IQ tests and in school, children must be able to:

Recognize, alter, and maintain changes in their behaviors and moods in ways that advance their cognitive performance (self-discipline).

Mentally tinker with something until getting it right, rather than giving up and saying “I don’t know” (perserverance).

Perfectionism can actually interfere with IQ. Very smart children usually do very well on tasks that have no time limit. But when required to work quickly without making mistakes, perfectionistic children can buckle under the pressure. They may be paralyzed by performance anxiety. They may refuse to be rushed, losing time in executing items to perfection.

Perfectionism can also interfere with social development. Children who are overly perfectionistic can become easily frustrated with peers who “don’t get it.” They may hold others to their own high standards, and criticize those who they see as falling short.

Perfectionism is not the same as OCD (Obsessive Compulsive Disorder). Children with OCD show strange behaviors and senseless compulsions. They may obsess about contamination, and so wash themselves in a specific, self-prescribed manner. They may obsess about getting things “just right,” and so rearrange objects into symmetry, touch or do things a certain number of times, or feel compelled to tie and retie their shoes. Frequently, children with OCD obsess about numbers. They may talk about “safe” or “unsafe” numbers, and aim to have items or behaviors occur in “safe” numbers. OCD interferes with functioning at home, at school, and in the community. OCD symptoms require lots of time, sometimes up to hours each day.

Normal child development includes phases of obsessions and compulsions. For example, between the ages of 4-8 many children engage in specific rituals (such as having a specific bedtime process, or wanting parents to respond with specific words). Fears about contamination (“cooties”) can also be common. Hoarding (collecting objects) is normal by the age of 7. Between the ages of 7-11, highly rituatlized and rule-bound play is normal. And, into teenage years, it is common for children to develop obessions about activities or idols.

You can help curb your child’s maladaptive perfectionism in several ways:

(1) Help your child alter her self-talk. She may believe that if someone does a task better than her, she is a complete failure. She may believe that you will criticize her if she makes a mistake. She may believe that others’ respect hinges on her being perfect.

(2) Help your child become aware of his perfectionistic tendencies. Show him that taking time to make every detail perfect delays his progress. Show him that messing up can provide opportunities for new ideas.

(3) Help your child see the positives. Point out what she is good at, and what others are good at. Encourage her to praise others’ abilities. Point out that, even if she did not do something perfectly, she may have had a lot of fun while doing it. Explain that spending positive time with school peers can be even more important than producing a flawless group project.

(4) Lead by example. Reassure yourself that your child will indeed make it in this competitive world. Enjoy learning for its own sake. Don’t obsess over standardized test scores. “Mess up” and be OK with it.

(5) Avoid overemphasizing accomplishments. Act on values that lead to greater life satisfaction, such as: spending time as a family, volunteering in your community, having fun, and doing things you’re good at (e.g., gardening, drawing, etc.).

(6) Don’t protect your child from disappointment. If he wants to quit soccer because he is not the best, encourage him to stick it out. If her school project is sloppy, avoid stepping in and doing it for her. Your child is not fragile. He can handle being disappointed. Defeat is a natural consequence, and there is no better teacher. Managing defeat and disappointment are critical skills children need in transitioning to college and workplaces. They’ll be more resilient if you allow them to “fail” as children.

If your child’s perfectionism cannot be altered, consider consulting with a child psychologist.

Good self-esteem is the ultimate buffer in kids’ lives. It bolsters them during failure. It navigates them through social pressures. It weathers their emotional (and hormonal) storms. It keeps their negative self-statements in check. Good self-esteem encourages kids to try new things. It helps them understand other people, and treat them well. It makes life more enjoyable. Self-esteem is not something kids build on their own. In fact, building self-esteem can have more to do with others than it does with the self.

Parents, your role in your child’s self-esteem is critical. From your child’s birth onward, you get more and more jobs in helping her develop positive self-esteem.

Birth to 1 Year: Good self-esteem starts when babies learn to fulfill their basic needs (love, hunger, comfort) by manipulating parents and caregivers. (“When I cry, Dad hugs me.”) There are 3 jobs for parents.

Love, adore, and cuddle your baby.

Give her everything she demands. There is no such thing as spoiling a child who is 0-6 months old. It takes a newborn a few months to realize he’s actually a separate person from his primary caregiver. (Can you imagine that a-ha moment?) After age 6 months, parents usually notice their child’s manipulation strategies are developing remarkably. You feel like a sucker. Still, meet her needs. But also start to teach effective communication skills. Children between 6-12 months are usually still in the pre-verbal stage; they cannot say what they want. For example, suppose a toy is not working and your son screams and shoves it in your face to fix it. First, validate his frustration (i.e., “Oh, it’s not working? That’s a bummer!”) Second, have him practice handing it to you nicely (i.e., “When you hand it to me without screaming, I’ll help you buddy.”) Third, think out loud as you fix the toy (i.e., “See this thing here. It’s not turning right. If I do this, it will work, see? Here, you try it.”)

Be a model for calm effort in working through problems…and checking the stupid batteries…

1 Year to 3 Years: Good self-esteem means feeling brave and secure enough to explore and try new things. There are 4 more jobs for parents:

Avoid “helicopter parenting” by smothering children. Nothing is so sweet as a safe moment to oneself. Encourage her unaccompanied excursions into the next room. Introduce him to the arts (i.e., banging on kitchen pans for drums). Praise her efforts, and the products of them (i.e., hang up her drawings on the fridge). Kids develop bravery by understanding that caregivers will keep them safe, and will be there if anything gets scary.

Don’t neglect your child. Make sure he is in supervised, child-proofed environments that will not punish exploration with injury. When accidents happen (…do coffee-table manufacturers have toddlers?), validate the injury (“Ouch!”) and explain how it can be avoided in the future.

Tell your child multiple times a day what INTRINSIC qualities you admire in her: sustained effort, working through frustration, showing care for others, athletic ability, smart reasoning, bravery, sense of humor, etc. When your child misbehaves, make a point to discourage the behavior, not the child. (“In our house, we don’t hit. You are not the kind of person who hits. Please take a time out.”) Do not under any circumstances apply negative labels to your child. Labels like “lazy,” “dramatic,” “babyish,” “worry wart,” and other unpleasant character appraisals shame your child, and have no positive impacts. Remember: Attribute good behaviors to your child’s character and bad behaviors to your child’s choices. (Behavior charts are a good way to get kids to behave without harming their self-esteem).

Model good self-esteem. Normalize mistakes. Don’t talk down about yourself. Don’t talk down about your spouse. Toddlers are using your skills to build their own. To children, parents are the most attractive, important, effective, and powerful people in the world. (Feeling better about yourself now?)

3-6 Years: Good self-esteem is being able to do stuff for oneself. There are 3 more jobs for parents:

Encourage and expect your child to take more and more responsibility for his Activities of Daily Living (ADL). These include: showering/bathing, brushing hair/teeth, getting dressed, using the toilet independently, feeding oneself appropriately, using the telephone/computer, taking care of pets, cleaning up after oneself, using safe behaviors (buckling self into the car seat), organizing school materials, and so on.

Expect more from your child. It’s OK if kids don’t get ADLs perfect. In fact, they won’t. But it is important that parents have reasonable expectations for children to try their best at each job. High demandingness is one very important part of good parenting. Mandate good effort in a matter-of-fact way. We all have to do things we don’t want to; that’s part of life.

Praise your child. Give warm support and even over-the-top, exaggerated cheers for jobs well done. Be sure to emphasize how proud you are of your child’s efforts, even if the outcome is not great. It’s not your imagination: your child IS incredibly unique, gifted, wonderful, and a genius at being himself. Let him know that.

6-11 Years: Good self-esteem means comparing oneself realistically to others and, in doing so, seeing self-worth. There are 3 more jobs for parents:

The focus for kids this age turns increasingly away from parents to other people (particularly peers). Kids compare themselves to others and see that there are often major differences. For most kids, differences will be both positive and negative. Your child realizes that he is not the best student in math. She sees that she is a great basketball player. He understands that others are more popular. She gets that other kids have family troubles. He sees that other people have more expensive clothes and gadgets. Parents should verbalize values for intrinsic skills and character, and not necessarily for achievements. Be realistic and positive in appraisals of your child. (“Yes, I suppose he is a better pitcher than you. He has spent a lot of time practicing and he’s sure talented. If you work hard, you may be as good as him. If not, no biggie. You’re great at understanding technology.”) Introduce your child to (books about) heroes of character and effort, not heroes whose only attributes are beauty, fame, or fortune (as they see on TV and other media).

Love the child you have, not the child you wanted to have. It’s time to come to terms with possible disappointments, and with, perhaps, your own childhood “failures.” Focus on the things you admire in your child, not on the ways you see her as falling short of your ideals. Strike the balance between pushing your child to do better and recognizing that she may be doing her very best. Indulge his passions, if they’re safe and appropriate.

Keep close ties with your child’s school. Teachers have valuable information about how your child relates to others. Good schools help teachers structure the classroom in ways that help all children feel accepted. Good teachers ensure that children do not feel inferior.

12-20 Years: Good self-esteem is knowing who you are, and who you are not. There are 3 more jobs for parents:

Teenagers have critical questions to answer about themselves, like “Who am I?,” “How do I fit in?,” and “What am I going to do in life?” Questions of identity relate to everything from hair color to religious views. Parents should permit this exploration, and support it. When you push too hard for your child to conform to your views, trouble happens. He may become confused about what’s important to him. Of course, there are family and societal values to be enforced: safe and ethical behaviors. Allowing your child to experiment with substances is not the thing to do. Permitting your child to dress provocatively is not the thing to do. But you may consider letting your child dye his hair. She should be able to select (safe) friends. He may wonder aloud (appropriately) about his sexual, religious, or political orientations.

Forming an identity can take a while. Be patient. This stage spans several years of awkward fashions, silly fads, and important work on the self. Continue to love and support your child through this sometimes difficult stage. Support especially the times when she sticks to her values, while peers do not. For example, praise your son when he elects not to drink alcohol at a teen party.

Avoid being defensive. For kids this age, everything is grist for the mill. Your child may call your rules too strict. She may accuse you of invading her privacy on Facebook or Twitter. He will say things at home aren’t fair. She may say your religious or political views are wrong. While taking into consideration your child’s view (she may have a good point!), remember that her accusations have more to do with her questions about herself. Matter-of-factly state your views, don’t attack his, and show your child how to communicate differences with respect.

An important, final note: mental illness is the arch enemy of good self-esteem. It ruthlessly attacks self-esteem. This can and does happen even for kids who have great parents. Mental illness can interfere with the development of good self-esteem from toddlerhood and up. When a child has poor self-esteem, particularly within the context of a supportive home environment, it’s a red flag for mental illness. The usual culprits are depression, anxiety, and attention problems. Signs of low self-esteem include:

Recurrent, unjustified shame and guilt

Hopelessness about the future

Feeling unlucky, punished, or “waiting for the other shoe to drop”

Suicidal ideas or behavior

Self-harm ideas or behavior

Children with good self-esteem have experiences–often provided to them by parents–that prepare them well for their future. They expect to succeed in what matters most to them.